Ensuring equal access to the latest cancer medicines is one of the most pressing challenges facing OECD health systems today. Despite the emergence of new oncology drugs, disparities in patient access—particularly through clinical trials and early access programs—remain a critical issue. Rising costs are also straining even the most affluent healthcare systems, making affordability a concern for all. This working paper examines various aspects of inequalities in access to cancer medicines, covering key stages in a medicine's life cycle, from marketing authorization to reimbursement decisions and uptake in clinical practice. The analysis draws on original findings from the 2023 OECD Policy Survey on Cancer Care Performance. It also explores potential strategies to stimulate competition among oncology medicine producers, which could create significant budget headroom, allowing reinvestment in new cancer medicines that offer substantial clinical benefits to patients.